SARS-CoV-2 in upper and lower airway samples of a laryngectomized patient: New insights and many lessons

• We report the presence of SARS-CoV-2 in the nasopharyngeal swab of a laryngectomee. • Viral nasal priming might modulate the systemic inflammatory response. • Smoking exposure is a risk factor for SARS-CoV-2 infection and multiple malignancies.

Molecular and immunologic analysis of laryngeal squamous cell carcinoma in smokers and non-smokers

BACKGROUND

Laryngeal squamous cell carcinoma (LSCC) is strongly associated with tobacco use, but recent reports suggest an increasing incidence of LSCC in patients without traditional risk factors, suggesting an alternative etiology of tumorigenesis. The purpose of this study is to characterize this non-smoking population and to compare immunohistochemical markers in tumor specimens from non-smokers and smokers with LSCC.

METHODS

A retrospective chart review of patients with LSCC at Johns Hopkins Hospital (JHH) was performed. A tissue microarray (TMA) was constructed with tumor specimen from non-smokers with stage and age-matched smokers and stained for a variety of immunologic and molecular targets.

RESULTS

In the JHH cohort of 521 patients, 12% (n = 63) were non-smokers. Non-smokers were more likely to be <45 years old at time of diagnosis (OR 4.13, p = 0.001) and to have glottic tumors (OR 2.46, p = 0.003). The TMA was comprised of tumors from 34 patients (14 non-smokers, 20 smokers). Only 2 patients (6%) were human-papillomavirus (HPV) positive by high-risk RNA in situ hybridization (ISH). There was no correlation between smoking status and p16 (p = 0.36), HPV-ISH positivity (p = 0.79), phosphatase and tensin homolog (PTEN, p = 0.91), p53 (p = 0.14), or programmed death-ligand 1 (PD-L1, p = 0.27) expression.

CONCLUSIONS

Non-smokers with LSCC are more likely to be younger at the time of diagnosis and have glottic tumors than smokers with LSCC. In TMA analysis of stage and age-matched specimens from smoker and non-smokers with LSCC, the pattern of expression for common molecular and immunologic markers is similar. Further, HPV does not appear to be a major causative etiology of LSCC in either smokers or non-smokers in our cohort of patients.

N-Acetyl-Beta-Glucosaminidase of Peripheral Blood Lymphocytes in Patients with Cancer of the Larynx

In 20 men, age 35 to 55 years, with cancer of the larynx, activity of N-acetyl-beta-glucosaminidase in peripheral blood lymphocytes was determined cytochemically according to Hayashi's method. Numbers of enzyme-positive cells were counted with regard to the type of cytochemical reaction (granular, granular-diffuse, or diffuse), and to the number of enzyme-positive lysosomal granules within a single cell. In comparison to 20 healthy men, age 20 to 30 years, the following changes were noted in the patients: 1) the decrease of the total count of enzyme-negative lymphocytes; 2) the decrease of the total count of lymphocytes with granular type of reaction; 3) the increase of the counts of lymphocytes with granular-diffuse and diffuse type of reaction. The authors suggest that these changes could be related to the immune reaction of specific tumor antigens.

Evaluation of the Specificity of the Leukocyte Migration Inhibition Test against Histologically Homologous and Heterologous Neoplastic Antigens in Cancer Patients

The aim of the present study was to verify whether the CMI response of the host's lymphocytes is directed towards tumor-associated antigens (TAA) specific for each histological type of tumor. The leucocyte migration inhibition (LMI) test was selected for this purpose, utilizing the cancer patients' leucocytes and, as neoplastic antigens, formalin-fixed cells of surgically removed cancer tissue. Two hundred and eighteen patients were studied, 110 of whom were affected by breast cancer, 48 by digestive tract and 60 by laryngeal cancer. The total amount of tests performed was 278. The leucocytes of 93 normal subjects were tested against the different tissues' cancer antigens, as were the leucocytes of 41 patients with cancer of different organs tested against the corresponding normal tissues' antigens. The breast cancer patients (122 tests performed) showed 82.35 % positive tests against homologous antigen, 72.72 % and 95.24 % against heterologous (digestive tract and laryngeal cancer, respectively) antigens. The digestive tract cancer patients (69 tests performed) showed 70.27 % positive tests against homologous, 66.66 % and 43.48 % against heterologous antigens (breast and laryngeal cancer, respectively). The laryngeal cancer patients (87 tests performed) showed 74.29 % positive tests against homologous, 38.10 % and 80.65 % against heterologous antigens (breast and digestive tract, respectively). The results led to the conclusion that the LMI test response of cancer patients was not « tissue specific »: the test did not discriminate between the homologous and the heterologous cancer antigens, and it seems that the response was not directed towards specific TAA but only towards wide-range or « group » TAA, shared by several types of tumors.

Production of Leukocyte Migration Inhibition Factor by Lymphocytes of Larynx Cancer Patients Stimulated by Laryngeal Carcinoma Solubilized Membrane Antigens

The production of leukocyte migration inhibition factor (LIF) from lymphocytes after stimulation with 3 M KCl soluble tumor and normal mucosa extracts was investigated in 30 patients with laryngeal carcinoma at different development stages and in 30 normal donors. The experiments were performed in heterologous and autologous systems. In heterologous systems 3 M KCl tumor extracts induced LIF production by heterologous lymphocytes from patients in 91 % of the cases, and normal mucosa extracts induced LIF production by heterologous lymphocytes from patients in 73 % of the cases and from normal donors in 90 % of the cases. In autologous systems 3 M KCl tumor extracts induced LIF production by autologous lymphocytes from the same patients in 65 % of the cases, whereas the normal laryngeal mucosa extracts induced LIF production by the same autologous lymphocytes in the 6 % of the cases. The high positivity percentage of the test in heterologous systems could be related to differences in the major histocompatibility complex. The 65 % test positivity in autologous systems using tumor extracts could be related to the presence of tumor associated antigens.

Specific Lif Production in Laryngeal Cancer Patients: Evidence of Suppressor Activity Exerted by Adherent Cells

The specific tumor-induced LIF production in 30 laryngeal cancer patients has been investigated before and after the removal of adherent cells to evaluate the existence of a suppressor activity. LIF production, after challenging lymphocytes with 3 M KCl autologous tumor extracts, was significant in 16 patients and showed a further significant increase after removal of adherent cells. A conversion to significance when the adherent cells were removed was shown in 6 patients, with no previous significant LIF production. These data suggest the existence of a suppressor activity exerted by adherent cells on LIF production in laryngeal cancer patients.

Neutrophil infiltration mediated by CXCL5 accumulation in the laryngeal squamous cell carcinoma microenvironment: A mechanism by which tumour cells escape immune surveillance

The CXCL5 chemokine is important for neutrophil accumulation in tumour tissues. In this report, we attempted to clarify whether and how infiltrating tumour-associated neutrophils (TANs) in laryngeal squamous cell carcinoma (LSCC) affect the proliferation and activation of T cells. We examined chemokine expression by real-time PCR (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) and performed an immunohistochemical analysis of LSCC microarrays. The relationship between CXCL5 and CD66b (a neutrophil marker) was investigated by immunofluorescence staining. We found that CXCL5 was upregulated in LSCC tissues, whereas CXCL5 levels were decreased in LSCC patient serum. Furthermore, high levels of CXCL5 were significantly correlated with intratumoural neutrophil infiltration. Compared with peripheral blood neutrophils (PBNs), TANs significantly inhibited T cell proliferation and decreased IFN-γ and TNF-α secretion. These data suggest that excessive neutrophil infiltration is associated with advanced clinical stages of LSCC (T3 or T4, III or IV, and N1 or N2).

Duodenal Contents Reflux-Induced Laryngitis in Rats: Possible Mechanism of Enhancement of the Causative Factors in Laryngeal Carcinogenesis

Objectives:

The main factors considered responsible for the onset of laryngeal cancer are tobacco smoking and alcohol abuse. Recently, gastroesophageal reflux has also been implicated as a causative factor in several laryngeal disorders, including laryngeal cancer. However, the significance of gastroesophageal reflux in laryngeal cancer is controversial.

Methods:

We investigated the histologic features of the esophagus and larynx in a rat model of reflux of the duodenal contents. Cell proliferation was also evaluated in laryngeal samples by detection of Ki67 antigen.

Results:

In this reflux model, laryngitis with infiltration of inflammatory cells and proliferation of small mucous glands was evident from 10 weeks after operation, and basal cell hyperplasia around the epiglottis and hyperplastic changes in the larynx were detected at 30 weeks. No dysplastic or malignant lesions were detected in the laryngeal samples within the duration of the experiment, in spite of detection of malignancy in 31.3% of lesions in esophageal samples at 30 weeks. The Ki67 index at each week was significantly higher than that of the control animals.

Conclusions:

Previous studies have shown smoking and alcohol abuse to have refluxogenic effects. Reflux of duodenal contents causes laryngitis. Reflux does not appear to be an independent risk factor for laryngeal carcinogenesis, but it may enhance the acknowledged etiologic risk factors, namely, smoking and alcohol abuse, by promoting cell proliferation.

Th17 expression and IL-17 levels in laryngeal squamous cell carcinoma patients

CONCLUSION

The Th17 cell frequency in peripheral blood and levels of IL-17 showed significant differences between patients with laryngeal squamous cell carcinoma and those with vocal cords polyps. Serum levels of IL-17 were correlated with laryngocarcinoma staging.

OBJECTIVES

To investigate associations among the frequency of Th17 cells, levels of IL-17, and laryngeal squamous cell carcinoma.

METHOD

Eighty in-patients with laryngeal squamous cell carcinoma and 114 in-patients with polypus of the vocal cord were enrolled. Th17 cell frequencies in peripheral blood and serum levels of IL-17 were measured by flow cytometry and enzyme-linked immunosorbent assay, respectively. The tissue expression levels of IL-17 mRNA transcripts and protein were measured using quantitative RT-PCR or immunohistochemical detection, respectively.

RESULTS

Th17 cell frequencies in peripheral blood and serum concentrations of IL-17 were significantly higher in patients with laryngocarcinoma compared with those in patients with polyps (p < 0.01 for both Th17 cells and IL-17 levels). Serum concentrations of IL-17 were significantly higher in patients with advanced laryngocarcinoma than in patients with early laryngocarcinoma (p < 0.01). The mRNA and protein levels of IL-17 were significantly higher in laryngocarcinoma tissues than in adjacent normal tissues (p < 0.01 for mRNA levels, p < 0.05 for protein levels).

[Mechanisms of immune system contribution to efficiency of antitumor cytostatic therapy]

Increasing the efficiency of antitumor therapy is one of major relevant tasks of oncology today. During recent years experimental evidence for active involvement of immune system in the regulation antitumor effects of cytostatic thereby has been obtained and theoretically justified. It was demonstrated that efficient cytostatic treatment is related to the cytotoxic activities of immune cells targeted against tumor cells. Such cytotoxic activities of immune cells are induced by radiotherapy or chemotherapy, where both innate and adaptive immune mechanisms are involved. However the disturbance in the functions of immune system can result in the impaired efficiency of cytostatic anti-tumor therapy. Cytotoxic agents can affect immune reactions by increasing the antigenic properties of tumor cells, facilitating their recognition of immune system, by stimulation of functional activation effector immune cells, elimination of immunosuppressive factors as well as systemic effects of antitumor therapy. A consideration of the crucial role of immune system in the providing of the efficiency of cytostatic antitumor therapy develops novel therapeutic approaches for treatment of malignant disorders based on balanced synergistic action of cytostatic agents and innovative immunomodulatory approaches.

Inflammation and cancer: role of annexin A1 and FPR2/ALX in proliferation and metastasis in human laryngeal squamous cell carcinoma

The anti-inflammatory protein annexin A1 (ANXA1) has been associated with cancer progression and metastasis, suggesting its role in regulating tumor cell proliferation. We investigated the mechanism of ANXA1 interaction with formylated peptide receptor 2 (FPR2/ALX) in control, peritumoral and tumor larynx tissue samples from 20 patients, to quantitate the neutrophils and mast cells, and to evaluate the protein expression and co-localization of ANXA1/FPR2 in these inflammatory cells and laryngeal squamous cells by immunocytochemistry. In addition, we performed in vitro experiments to further investigate the functional role of ANXA1/FPR2 in the proliferation and metastasis of Hep-2 cells, a cell line from larynx epidermoid carcinoma, after treatment with ANXA1_2–26 (annexin A1 N-terminal-derived peptide), Boc2 (antagonist of FPR) and/or dexamethasone. Under these treatments, the level of Hep-2 cell proliferation, pro-inflammatory cytokines, ANXA1/FPR2 co-localization, and the prostaglandin signalling were analyzed using ELISA, immunocytochemistry and real-time PCR. An influx of neutrophils and degranulated mast cells was detected in tumor samples. In these inflammatory cells of peritumoral and tumor samples, ANXA1/FPR2 expression was markedly exacerbated, however, in laryngeal carcinoma cells, this expression was down-regulated. ANXA1_2–26 treatment reduced the proliferation of the Hep-2 cells, an effect that was blocked by Boc2, and up-regulated ANXA1/FPR2 expression. ANXA1_2–26 treatment also reduced the levels of pro-inflammatory cytokines and affected the expression of metalloproteinases and EP receptors, which are involved in the prostaglandin signalling. Overall, this study identified potential roles for the molecular mechanism of the ANXA1/FPR2 interaction in laryngeal cancer, including its relationship with the prostaglandin pathway, providing promising starting points for future research. ANXA1 may contribute to the regulation of tumor growth and metastasis through paracrine mechanisms that are mediated by FPR2/ALX. These data may lead to new biological targets for therapeutic intervention in human laryngeal cancer.

Analysis of serum cytokine levels in larynx squamous cell carcinoma and dysplasia patients

BACKGROUND

Although the imbalance of cytokines in Head and Neck Squamous Cell Carcinoma (HNSCC) is well known, there is scarce data regarding its occurrence during dysplasia, before the malignant transformation.

OBJECTIVE

To determine whether laryngeal dysplasia patients show a different cytokine profile than patients with cancer and healthy controls.

METHODS

Seventeen newly diagnosed, untreated larynx squamous cell carcinoma (SCC) and six laryngeal dysplasia patients as well as 22 healthy controls were analyzed for circulating cytokines. A flowcytometry Th1/Th2 cytokine array kit was used to quantitatively measure Interleukin-2 (IL-2), IL-4, IL-6, IL-10, Tumor Necrosis Factor-α (TNF-α) and Interferon-γ (IFN-γ) levels. Additionally, IL-8 levels were determined through ELISA.

RESULTS

IL-6, IL-8 and IL-10 were determined to be statistically increased in SCC patients (p<0.05). IL-8 and IL-10 levels were also higher in SCC patients than dysplasia patients (p<0.05). Additionally, IL-6 and IL-10 were all found to be markedly increased in dysplasia patients compared with controls (p<0.05).

CONCLUSION

Our results demonstrate an imbalance of IL-6 and IL-10 not only in HNSCC but also in laryngeal dysplasia.

Expression and prognostic value of MAGE-A9 in laryngeal squamous cell carcinoma

BACKGROUND

Melanoma-associated antigen (MAGE) family genes are reported to play important roles in the development of human cancers. However, the relationship between the expression of MAGE-A9 and clinicopathological characteristics in human laryngeal carcinoma remains unclear. This study aimed to examine the expression of MAGE-A9, and to evaluate the clinical significance of its expression in human laryngeal squamous cell carcinoma (LSCC).

METHODS

Quantitative real-time reverse transcription-PCR (qPCR) and immunohistochemistry (IHC) were performed to characterize the expression of MAGE-A9 in LSCC tissues and tumor-adjacent normal tissues. Kaplan-Meier survival and Cox regression analyses were performed to evaluate the prognosis of patients with LSCC.

RESULTS

The expression of MAGE-A9 was significantly higher in LSCC than in tumor-adjacent normal tissues. Cytoplasmic expression of MAGE-A9 was detected in 70 of 123 (56.9%) LSCC specimens. Levels of MAGE-A9 in LSCC were related to histopathological grade (P = 0.024). Kaplan-Meier survival and Cox regression analysis revealed that MAGE-A9 expression level and lymph node metastasis were independent prognostic factors of LSCC (P = 0.005; P = 0.001, respectively).

CONCLUSIONS

Our study suggests that MAGE-A9 expression is a prognostic biomarker for LSCC patients. High expression of MAGE-A9 indicates unfavorable survival outcome in LSCC patients.

Pharyngolaryngeal location of Kaposi's sarcoma with airway obstruction in an HIV-negative patient

Kaposi's sarcoma (KS) is a human herpes virus-8 (HHV-8)-associated angioproliferative disorder, and its occurrence may be favored by human immunodeficiency virus (HIV) infection and iatrogenic immunosuppression. It has also been postulated that a chronic inflammatory disease of the skin can pave the way to its development. KS generally involves mucosal and cutaneous sites, including the head and neck. An oropharyngeal location is quite common, but laryngeal involvement with possible upper airway obstruction and respiratory distress requiring tracheotomy is rare, and no hypopharyngeal locations have yet been reported. We describe the case of a 68-year-old male patient who developed KS after immunosuppressive treatment for pemphigus vulgaris, an autoimmune bullous disease presenting with blisters and erosions on the skin and the oral mucosa. KS was initially localized to the oral cavity and oropharynx, but subsequent involvement of the laryngeal and hypopharyngeal tract led to acute airway obstruction and the need for tracheotomy. This unique case of pharyngolaryngeal KS suggests that clinicians faced with purple nodular lesions should consider a differential diagnosis of KS in immunocompromised patients, even if they are HIV negative, and should carefully manage the patency of the upper airways.

Expression of selected regulatory molecules on the CD83+ monocyte-derived dendritic cells generated from patients with laryngeal cancer and their clinical significance

B7H1 and B7H4 overexpression is associated with inhibition of the immune system in many solid tumors, and altogether with CD200 molecule plays an important role in tumor invasion by promoting malignant transformation. However, there is no report about impact of these molecules on laryngeal squamous cell carcinoma. The objective of the present study was to assess by means of flow cytometry the expression of B7H1, B7H4, CD200, and CD200R on CD83+ monocyte-derived dendritic cells (Mo-DC), pulsed with autologous tumor cell lysates (aTCL) in patients who suffer from G1, G2, or G3 laryngeal carcinoma (LC, n = 60) in comparison to healthy donors (HD, n = 15). It has been demonstrated that median value of the percentages of CD83+ B7H1+, CD83+ B7H4+, and CD83+ CD200+ cells were higher in LC patients than HD (p = 0.041, p ≤ 0.0001, and p = 0.02, respectively). Mean fluorescence intensity (MFI) of CD200, CD200R, B7H1, and B7H4 on the Mo-DC pulsed with aTCL of the patients was also higher than on the Mo-DC of HD (p ≤ 0.0001, p ≤ 0.0001, p = 0.002, and p ≤ 0.0001, respectively). The highest MFI levels of all molecules were noted in grade 3 LC. The aforementioned results prove that there is a relation between the presence of laryngeal cancer and the expression of B7H1, B7H4, CD200, and CD200R regulatory molecules on the CD83+ Mo-DC pulsed with autologous cancer cell lysates. Strong association of LC grade and the tested antigens expression suggests a critical role for these proteins in LC biology.

[Laryngeal papillomatosis: problem update]

The objective of the present overview was to analyse the available data on etiology, pathogenesis, diagnostics, and treatment of laryngeal papillomatosis. It is shown that the pathogenetic mechanism underlying the development of this pathology is related to cell proliferation mechanisms. The human papilloma virus is most effectively identified by the polymerase chain reaction technique in combination with in situ hybridization. It is expected that new and more informative criteria for diagnostics, treatment,and prognosis of laryngeal papillomatosis will be proposed based on recent progress in molecular biology, morphology,and immunology. Different variants of the therapeutic strategy for the treatment of laryngeal papillomatosis are described.Modern practice of the management of laryngeal papillomatosis takes advantage of the three main approaches and/or their combination. First, further improvement of surgical techniques, such as the application of endoscopic devices and surgical lasers.Second, the search for new pharmaceutical agents (indole-3-carbinol, cidofovir, antiviral medicines, etc.) most frequently used for adjuvant therapy. Third, the development of new vaccination methods. Besides these three approaches, photodynamic therapy and the use of ionizing radiation are currently being studied as the tools for the treatment of extensive and recurrent laryngeal papillomatosis as well as the methods of laser-induced interstitial thermotherapy.

Dendritic cells: friends or foes of laryngeal cancer?

BACKGROUND

Dendritic cells are important keyplayers of various malignant tumors but less studied in laryngeal malignancies. We assessed the immunohistochemical expression and distribution of dendritic cells in different types of laryngeal carcinomas and tried to find if they could influence evolution and prognosis of such malignancies.

MATERIALS AND METHODS

Immunohistochemistry was applied on 49 laryngeal tumors. Dendritic cells were identified by using S100 protein staining. The specimens were then evaluated for dendritic cells presence, number and distribution.

RESULTS

S100 positive cells were identified in all cases of squamous cell carcinoma, being absent in the case of adenoid cell carcinoma. Squamous cells carcinomas had the highest numbers of S100 positive cells. For them, we encountered an inverse correlation between peri- and intra-tumor S100 positive cells density. Intraepithelial dendritic cells density was lower for undifferentiated squamous cell carcinoma, also as for stroma of well-differentiated squamous cell carcinoma. Poorly differentiated carcinoma had a higher density of stromal S100 positive cells. S100 positive cells were identified in tumor area with squamous differentiation in all cases, and in peritumor area in 41 cases (83.67%). S100 positive cells density was correlated with tumor grade but not with invasion.

CONCLUSIONS

Taking together, our results suggest that migration of stromal dendritic cells inside tumor areas could be an important component of the antitumor immune response induction and thus, S100 positive dendritic cells may be considered as a favorable prognostic factor in laryngeal carcinomas.

[Silencing of SOCS1 and IL-12 gene cotransferred by adenoviral enhances DC-mediated anti-laryngocarcinoma immunity in vitro]

OBJECTIVE

To investigate the effects and the related immunological mechanisms of dendritic cells (DCs) modified by SOCS1siRNA gene and IL-12 gene on activating and inducing cytotoxic T lymphocyte (CTL) as well as specific immune critically killing laryngocarcinoma in vitro.

METHOD

DCs were derived from human peripheral blood mononuclear cells (hPBMC), modified by recombinant SOCSlsiRNA adenoviral and IL-12 adenoviral and then pulsed with tumor antigen of repeated freeze-thaw method. The IL-12 and IFN-y levels in culture supernatant of DCs and CTILs were examined by ELISA.

RESULT

DC were cultivated successfully and had special morphologic haracteristicistics. The rate of Ad-GFP carrying fluorescent expression was over 90%. The expression of SOCS1 protein in DCs were effectively decreased by being modified SOCSlsiRNA and IL-12 genetic while the expression of IL-12 protein were increased. The secretion rate of IL-12 factor was higher than that of SOCSlsiRNA and IL-12 transfection of single gene respectively in modified DCs which could prompt T cell proliferation activation significantly as well. IFN-y was secreted constantly in DC and CTL, resulting in Hep-2.

CONCLUSION

DC modified by SOCSlsiRNA and IL-12 gene which pulsed with laryngeal carcinoma antigen could increased the production of IL-12 and IFN-y; DC modified by SOCSlsiRNA and IL-12 gene which pulsed with laryngeal carcinoma antigen could enhance the ability to stimulate proliferation of T cell, increase production of IFN-y, IL-12 by T cells and induce the stronger killing rate of CTL.

[Association of antigen processing machinery and HLA class I defects with clinicopathological outcome in laryngeal squamous cell carcinoma]

OBJECTIVE

To investigate the role of antigen-processing machinery (APM) component defects in HLA class I antigen down-regulation in laryngeal squamous cell carcinoma (SCC) and to assess the clinical significance of these defects.

METHODS

Fifty-one formalin-fixed, paraffin-embedded SCC specimens were examined for the expressions of APM component transporter associated with antigen processing (TAP1) and low molecular weight polypeptide (LMP-7) and HLA class I antigen by immunohistochemistry.

RESULTS

HLA class I antigens, TAP-1 and LMP-7 expressions were down-regulated in 56.9% (29/51), 39.2% (20/51) and 45.1% (23/51) of the tested specimens respectively, whereas HLA class I antigens, TAP-1 and LMP-7 expressions lost in 21.6% (11/51), 33.3% (17/51) and 27.5% (14/51) of the tested specimens respectively. TAP-1 and LMP-7 expressions were significantly correlated with HLA class I antigen expression (r=0.460, P<0.05 and r=0.685, P<0.05, respectively). HLA class I antigens down-regulation was significantly correlated with T stage (χ2=8.61, P<0.05). Both TAP-1 and LMP-7 down-regulations were significantly correlated with T stage (χ2 values were 9.72 and 8.97 respectively, P<0.05) and TNM stage (χ2 values were 9.18 and 7.70 respectively, P<0.05). TAP-1, LMP-7 and HLA class I antigen down-regulations were significantly associated with reduced patients' overall survival (P<0.05) and disease-free survival (P<0.05). Multivariate analysis showed lymph node metastasis, recurrence and HLA class I antigen down-regulation were unfavorable prognostic factors (P<0.05).

CONCLUSIONS

Down-regulated expressions of HLA class I antigen and APM component TAP-1 and LMP-7 occur frequently in laryngeal squamous cell carcinoma, by which cancer cells could avoid immune surveillance, while HLA class I antigen down-regulation is a major contributing factor to tumour progression and mortality.

[Study of testicular cancer gene expression in samples of oral leukoplakia and squamous cell carcinoma of the mouth]

Cancer-testis (CT) antigens are normally expressed mostly in human germ cells, there is also an aberrant expression in some tumor cells. This expression profile makes them potential tumor growth biomarkers and a promising target for tumor immunotherapy. Specificity of CT genes expression in oral malignant and potentially malignant diseases, e.g. oral leukoplakia, is not yet studied. Data on CT genes expression profile in leukoplakia would allow developing new diagnostic methods with potential value for immunotherapy and prophylaxis of leukoplakia malignization. In our study we compared CT genes expression in normal oral mucosa, oral leukoplakia and oral squamous cell carcinoma. We are the first to describe CT genes expression in oral leukoplakia without dysplasia. This findings make impossible differential diagnosis of oral leukoplakia and squamous cell carcinoma on the basis of CT genes expression. The prognostic value of CT genes expression is still unclear, therefore the longitudinal studies are necessary.

[Analysis of serum T-lymphocyte subsets and NK cell activity in patients with squamous cell carcinoma of pharynx and larynx]

OBJECTIVE

To investigate the alteration of T-lymphocyte subsets and NK activity in patients with squamous cell carcinoma of pharynx and larynx.

METHOD

T-lymphocyte subsets and NK activity were determined by flow cytometry in 123 patients with squamous cell carcinoma of pharynx and larynx. Blood samples of 36 nontumor patients were used as control.

RESULT

The total T lymphocytes were lower in patients with squamous cell carcinoma of pharynx and larynx than control group significantly (P < 0.05). The levels of helper lymphocyte subsets were little lower than those in control group(P > 0.05). On the other hand, the levels of suppressor lymphocytes in patients were higher than those in the control group (P < 0.05). Therefore, the CD4/CD8 ratios in patients were lower than those of the control group statistically (P < 0.05). There was no statistical difference in activated T lymphocytes and total B lymphocytes (P > 0.05), but NK activity in patients were lower than those in control group significantly (P < 0.01). There was no statistical difference in total T lymphocytes between stage I-II and stage III--IV (P > 0.05). The levels of helper lymphocyte subsets in stage I-II patients were little higher than in stage III-IV patients (P > 0.05), but the levels of suppressor lymphocytes in stage I-II patients were lower than in stage III-IV patients (P < 0.01). The CD4/CD8 ratios in stage I-II patients were significantly higher than in stage III-IV patients (P < 0.01). The levels of total B lymphocytes in stage I-II patients were significantly higher than in stage III-IV patients (P < 0.05). The activated T lymphocytes and NK activity did not changed statistically (P > 0.05).

CONCLUSION

The immune function in patients with squamous cell carcinoma of pharynx and larynx is disordered and lower. With advanced stage disease, not only the cellular immune function in patients decrease gradually, but also the humoral immunity is lower. Analyzing T-lymphocyte subsets and NK activity determined by flow cytometry would be easy and helpful to evaluate the immunologic condition of every patient.

Expression of the nonclassical HLA-G and HLA-E molecules in laryngeal lesions as biomarkers of tumor invasiveness

INTRODUCTION

HLA-G and HLA-E are two nonclassical class I molecules, which have been well recognized as modulators of innate and adaptive immune responses, and the expression of these molecules in virus infected cells has been associated with subversion of the immune response.

OBJECTIVE

In this study we performed a cross-sectional study, systematically comparing the expression of HLA-G and HLA-E in benign, pre-malignant and malignant laryngeal lesions, correlating with demographic and clinical variables and with the presence of high-risk and low-risk HPV types.

MATERIALS AND METHODS

Laryngeal lesions were collected from 109 patients and stratified into 27 laryngeal papillomas, 17 dysplasias, 10 in situ laryngeal carcinomas, 27 laryngeal carcinomas without metastases, 28 laryngeal carcinomas with metastasis along with their respective draining cervical lymph nodes, and 10 normal larynx specimens. The expression of HLA-G and HLA-E molecules was determined by immunohistochemistry. HPV DNA detection and typing was performed using generic and specific primers.

RESULTS

HLA nonclassical molecules showed a distinct distribution pattern, according to the larynx lesion grade. HLA-G expression increased in benign and premalignant lesions, and gradually decreased in invasive carcinomas and in respective draining cervical lymph nodes. Conversely, HLA-E expression increased as far as lesion grade increased, including increased molecule expression in the draining lymph nodes of malignant lesions. Only 17 (15.6%) patients were HPV DNA positive.

CONCLUSIONS

Overexpression of HLA-E and underexpression of HLA-G appear to be good markers for malignant larynx lesion.

Cancer-derived matrix metalloproteinase-9 contributes to tumor tolerance

BACKGROUND AND AIMS

Tumor-specific T regulatory cells (Treg) play a critical role in tumor cell survival. The development of tumor-specific Treg is not fully understood. This study aims to elucidate the role of matrix metalloproteinase (MMP)9 in tumor tolerance development.

METHODS

We recruited 38 patients with laryngeal cancer (LC) in this study. MMP9 levels in the LC were measured by western blotting. Immune cells were isolated from LC tissue for indicated experiments. The cells' activities were characterized by flow cytometry.

RESULTS

High levels of MMP9 were detected in LC that plays a critical role in the development of tolerogenic dendritic cells and LC-specific Tregs. The isolated LC Tregs have the ability to suppress tumor-specific CD8 T cells in a tumor antigen-specific manner.

CONCLUSIONS

This study reveals a novel mechanism in tumor tolerance in which MMP9 plays a critical role in tumor survival. The data imply that MMP9 may be a potential target in the treatment of malignant tumors.

Serum perioperative profile of cytokines in patients with squamous cell carcinoma of the larynx

OBJECTIVE

Altered immune, inflammatory, and angiogenesis responses have been noticed in head and neck cancer, and many of these responses have been associated with a poor clinical outcome. The objective of this study was to evaluate several immune mediators in the sera of patients with squamous cell carcinoma (SCC) of the larynx undergoing curative surgery in connection with clinicopathologic factors.

METHODS

Multiplex analysis of cytokines (interleukin [IL]-6, IL-8, IL-10, tumour necrosis factor α [TNF-α], interferon-γ [IFN-γ]), chemokines (monocyte chemoattractant protein 1 [MCP-1], macrophage inflammatory protein 1α [MIP-1α], and epithelial neutrophil-activating protein 78 [ENA-78]), and growth factors (vascular endothelial growth factor and basic fibroblast growth factor) in the serum of patients with laryngeal cancer and healthy controls was performed using xMap technology.

RESULTS

Patients with SCC presented an altered cytokine profile compared to healthy controls, both preoperatively (higher levels of IL-8 and IL-10) and postoperatively (higher values for IL-6, IL-8, IL-10, and TNF-α). Heavy smoking was associated with significantly lower levels of ENA-78 and higher levels of IL-8.

CONCLUSION

Differences noticed in patients' immune mediator profiles seem to be attributable to both disease and treatment. Further longitudinal studies are necessary to elucidate the involvement of immune mediators in disease progression and clinical evolution.

[T lymphocyte function in laryngectomized patients]

AIM

Malignant tumors of the larynx account for 2.3% of all malignancies, while their frequency among tumors of the head and neck ranges between 12% and 20%. Research on the general immune competence in patients with malignant diseases has provided useful insight in the relationship between immune disorders on one side and the clinical course on the other. Unfortunately, only few complete studies have been published so far with this regard in patients with malignant tumors of the larynx, and therefore our study was essentially aimed at establishing of general immunocompetence, presence and levels of the possible immune disorders and their association with the malignant tumors.

MATERIAL AND METHOD

The study included forty two patients with primary squamocellular laryngeal cancer. All the patients underwent surgery, out of whom fifteen were treated postoperatively with radiotherapy. We tested the immune competence prior to the operation and in the postoperative period nine months later. In the venous blood we examined T lymphocyte function, monocyte levels and mononuclear phagocyte function.

RESULTS

Preoperative evaluation of the presence and levels of general immune competence in patients with laryngeal cancer, showed a distinct decrease in the proliferative response to the PHA mitogen in vitro, with a tendency to normalize in patients who do not develop a relapse of the disease or distant metastasis during the follow-up period. During the whole study period, the number of monocytes and mononuclear phagocyte activity was above the normal level.

CONCLUSION

The patients with operable laryngeal carcinoma had considerable immune disorders at various levels, primarily at the level of T lymphocytes. Of all the disorders, reduced mitotic activity of T lymphocytes in response to mitogens showed the highest dependance on the presence of malignant tissue in the organism.

[Clinical study on cytokine induced killer cells therapy to laryngeal cancer after radiotherapy]

OBJECTIVE

To observe the immunity changes of patients after CIK cells being transfused back, and then to discuss the effects of CIK cells on curing laryngeal cancers.

METHOD

Forty eight laryngeal cancer patients with low immune function were collected. The immunity index in the peripheral blood of patients before/after radiotherapy and after CIK cells therapy were measured and compared with normal one.

RESULT

After radiotherapy, the percentage of CD3+, CD4+ cells declined, the percentage of CD8+ cells increased; the rate of CD4+ /CD8+ declined and the rate of Th1/Th2 reversed. There were no significant difference between the immunity indexes before and after radiotherapy (P < 0.05). After CIK cell therapy, the above indexes were improved (P < 0.05), but the values didn't returned to normal. After radiotherapy and after CIK therapy, the value of B cell didn't changed obviously (P > 0.05), while the percentage of NK cells changed obviously (P < 0.05).

CONCLUSION

Radiotherapy can restrain the immune function of the patients with laryngeal cancers. CIK therapy is safe and might improve the recent immune function of the patients.

Prognostic value of the immunological phenomena and relationship with clinicopathological characteristics of the tumor--the expression of the early CD69+, CD71+ and the late CD25+, CD26+, HLA/DR+ activation markers on T CD4+ and CD8+ lymphocytes in squamous cell laryngeal carcinoma. Part II

One of the most important challenges in contemporary oncology is to find objective biomarkers of tumor aggressiveness, which help to identify more invasive phenotypes of the carcinoma. The purpose of this study was to investigate the relationships between the early and the late activation markers expression on T CD4(+) and CD8(+) cells subpopulations and certain clinicopathological characteristics of the neoplastic infiltration in order to determine their role as biomarkers for tumor behavior in squamous cell laryngeal carcinoma. Analysis of the early (CD69(+), CD71(+)) and the late activation antigens (CD25(+) (high), CD26(+), HLA/DR(+)) expression on T CD4+ and CD8(+) lymphocytes by cytofluorymetry in 55 patients treated for squamous cell laryngeal carcinoma was performed. Clinicomorphological analysis on the basis of TNM criteria and tumor front grading, which included tumor-related features and adjacent stroma-related characteristics of the peripheral edge of infiltration was carried out. The relationships between the activation markers expression and parameters of tumor aggressiveness were investigated. Our work revealed statistically significant differences in the expression of the studied activation markers on T cells with regard to certain clinicomorphological features. The expressions of CD69(+) and CD71(+) antigens on T CD3(+)CD4(+) and CD3(+)CD8(+) cells as well as CD4(+)HLA/DR(+) markers were higher for pT3 and pT4 tumors, in comparison with pT2 carcinomas. Moreover, tumors with the smallest number of TFG points were characterized by significantly lower values of the average expression of CD3(+)CD69(+) and CD3(+)CD71(+) as well as CD4(+)HLA/DR(+) markers on T lymphocytes. In addition, more aggressive and deeply infiltrating laryngeal carcinomas were most often characterized by significantly higher values of the average expression of CD69(+) and CD71(+) antigens on CD8(+) as well as HLA/DR(+) markers on CD4(+). Our study confirmed the implication of the early and the late activation antigens expression on CD4(+) and CD8(+) T lymphocytes in clinicomorphological parameters of the tumor, especially TFG total score and depth of invasion, and their importance as indicators of the invasive phenotype of laryngeal carcinoma.

[Expression and clinical significance of CCR6, CCR7 and CD4(+)CD25(+) Foxp3(+) regulatory T cells in laryngeal squamous cell carcinoma and neck lymphatic metastasis]

OBJECTIVE

To evaluate the expressions and clinical significance of chemokine receptor 6 (CCR6), chemokine receptor 7(CCR7) and CD4(+)CD25(+)Foxp3(+) regulatory T cells (Treg) in laryngeal squamous cell carcinoma (LSCC) and metastatic lymph nodes.

METHODS

Blood samples and fresh specimens of LSCC were obtained from 50 LSCC patients treated. Blood samples from normal subjects were donated by 20 volunteers. The mRNA expressions of CCR6, CCR7 and their ligands CCL20, CCL19/CCL21 were detected by real-time quantitative RT-PCR. Expressions of CCR6 and CCR7 proteins were examined with immunohistochemistry. Flow cytometry was used to investigate Treg in peripheral blood mononuclear cells.

RESULTS

The relative expression levels of CCR6, CCR7 and CCL19 mRNA in tumor tissues with lymphatic metastases were significantly lower than those without lymph node metastases (P < 0.05), while the relative expression level of CCL20 mRNA in tumor tissues with lymphatic metastases was significantly higher than that of those without metastatic lymph nodes (t = 2.39, P < 0.05). Immunohistochemistry showed that the expression levels of CCR6 and CCR7 in tumor tissues in patients with lymph node metastases than those without lymph node metastases. CCR6 and CCR7 expressions were also detected in metastatic lymph nodes. Flow cytometry showed that the percentage of Treg in blood in LSCC patients was significantly higher than that in normal subjects (t = 2.19, P < 0.05), and those with lymph node metastasis had a much higher percentage of Treg (t = 2.14, P < 0.05).

CONCLUSIONS

CCR6, CCR7 and Treg could take part in the process of lymph node metastasis in LSCC patients.

[Human survivin modified DCs vaccine inhibits laryngeal cancer in vivo and in vitro]

OBJECTIVE

Construction of human full-length survivin gene-modified DCs vaccine and observe the biological characteristics and the role of laryngeal cancer treatment.

METHODS

Construction of homologous recombination through the full-length survivin-human adenovirus (pAd-sur), and transfection of immature DCs, induced by access to sophisticated cultivate DCs, the proliferation of activated T lymphocytes; DCs vaccine different groups observed in vitro, in vivo biological activity.

RESULTS

The success in bringing human to build a full-length survivin gene recombinant adenovirus vector pAd-sur; get with the typical characteristics of DCs, the expression level of the surface molecules of up to CD1a 46.2%, CD80 64.2%, CD83 80.5%, HLA-DR 84.3%, vaccine for in vitro cell killing rate 51.5%, compared with the control group, the difference was significant (t = 7.1358, P < 0.01). Gene-modified tumor cell vaccine group was 54.9% of apoptosis and necrosis rate of 21.9%, compared with the control group, the difference was significant (t value was 33.0209 and 17.5057, all P < 0.01).

CONCLUSION

Human full-length survivin gene modified, DCs The expression of surface molecules than the rate of gene-modified DCs without a significant increase, with more to stimulate T lymphocyte proliferation, and promote secretion of gamma-IFN; in vivo, in vitro to promote the ability of anti-laryngeal cancer cells.

Immunohistochemical staining of Ki-67 using the monoclonal antibody Ki-s11 is a prognostic indicator for laryngeal squamous cell carcinoma

BACKGROUND

Proliferative activity has been shown to be of prognostic significance for several malignancies. Ki-67, a cell cycle associated antigen, is regarded as a promising proliferation marker. Very few results on the proliferative activity of head and neck cancer and their potential prognostic value are available.

MATERIALS AND METHODS

The proliferative activity of 104 squamous cell carcinomas of the larynx (SCCL) was analyzed retrospectively with the monoclonal antibody Ki-S11 which specifically detects the Ki-67 antigen. Median follow-up time was 47 months.

RESULTS

There was a statistically significant correlation (p<0.05) between histopathological grading, N-status and proliferative activity. There was also a significant difference for the 5-year survival between low and highly proliferating tumours. The patient group with low proliferating laryngeal cancer had a statistically (p<0.05) longer absolute and recurrence-free 5-year-survival time than patients with a highly proliferating cancer.

CONCLUSION

These results show that Ki-67 staining of SCCL with Ki-S11 is a helpful prognostic indicator for squamous cell carcinoma of the larynx with a potential clinical application.

[Biological characteristics of highly tumorigenic CD44+CD133+ subpopulation of laryngeal carcinoma cells]

OBJECTIVE

To separate the cell subpopulation with high tumorigenic ability and study the biological characteristics of this subpopulation in laryngeal carcinoma cells.

METHODS

Human laryngeal carcinoma cells were obtained by primary tissue culture technique. CD44 and CD133 molecules were used as markers to isolate the CD44(+), CD133(+), CD44(+)CD133(+) and CD44(+)CD133(-) cell subpopulations from the laryngeal carcinoma cells by flow cytometry. A nude mouse tumor xenograft model was developed for the study of the tumorigenic effects of the different cell populations. 1 x 10(6), 1 x 10(5), 1 x 10(4) and 1 x 10(3) cells were injected into the left flank of the mice, respectively. The mice were observed for palpable tumor formation and were sacrificed at 4 weeks later to assess the tumor formation rate, tumor volume and tumor weight. Boyden chamber migration assay was used to determine the migration ability and immunochemistry was used to detect the expression of stem cell antigen SCA-1 and beta1-integrin. Semi-quantities RT-PCR and Western blot analysis were performed to detect the expression level of Bmi-1 in the different cell subpopulations.

RESULTS

The growth of subcutaneous tumors in nude mice showed that a tumor can be generated with 1 x 10(3) CD44(+)CD133(+) cells. When the same dose of 1 x 10(6) CD44(+)CD133(+) cells was injected into the mice, both the average weight and volume of the tumors were significantly higher than those generated from other cell subpopulations. Boyden chamber migration assay showed that the invasion ability of CD44(+)CD133(+) cells was significantly higher than that of other cell subsets. The results of immunochemical analysis showed an abundant expression of stem cell antigen SCA-1 and beta1-integrin in the CD44(+)CD133(+) cells. Semi-quantitative RT-PCR and Western blot analysis provided strong evidence that the Bmi-1 expression in CD44(+)CD133(+) and CD133(+) cells was very significantly higher than that in CD44(+), CD44(+)CD133(-) and control cells (P < 0.01).

CONCLUSION

Our findings demonstrate that CD44(+)CD133(+) subset cells in laryngeal carcinoma posses some biological characteristics of tumor stem cells, which may be the original cells of laryngeal carcinoma and may become a new target of tumor therapy.

Impact of EGFR immunoexpression on STAT3 activation and association with proinflammatory/regulatory cytokine pattern in laryngeal squamous cell carcinoma

Stimulation of epidermal growth factor receptor (EGFR) results in the activation of signal transducer and activator of transcription-3 (STAT3), a transcriptional factor associated with carcinogenesis. Proinflammatory cytokines are capable of activating a tumor cell death program by reducing EGFR tyrosine phosphorylation. This study aimed to identify EGFR expression in laryngeal carcinoma and determine the relationship with STAT3 and proinflammatory/regulatory cytokine secretion. An analysis of EGFR expression (membranous EGFR-m and cytoplasmic EGFR-c) was performed in tumor tissues by immunohistochemical (IHC) staining in 45 medical cases of laryngeal carcinoma. STAT3 expression in freshly isolated tumor and non-cancerous normal epithelial cells by RT-PCR was analyzed in 24 patients after total larynx resection. The concentrations of TNFalpha, IL-2, IL-6, IL-8 and IFNgamma secreted by purified peripheral blood mononuclear cells (PBMCs) or contained in whole blood samples were measured by ELISA. The relationship between EGFR and mRNA STAT3 expression as well as the level of secreted cytokines was investigated. In our study, 93.3% tumors expressed EGFR-m and 37.8% EGFR-c. It also revealed a statistically significant dependence of the EGFR status on STAT3 expression in neoplastic tissues. Tumors with IHC EGFR-m positive staining >50% of the total number of cells, as well as with EGFR-c positive staining, were characterized by the most frequent presence of STAT3 expression. Our data demonstrate a significant negative relationship between EGFR-m expression and TNFalpha concentration, and a positive connection between membranous EGFR and IL-8 or IFNgamma levels recorded in isolated PBMCs. Furthermore, this study revealed a significant relationship between EGFR-c immunoexpression and IL-8 or IFNgamma concentration. Our findings have confirmed a key role of EGFR in determining the proliferative and malignant potential of laryngeal carcinoma.

Adhesion/growth-regulatory tissue lectin galectin-1 in relation to angiogenesis/lymphocyte infiltration and prognostic relevance of stromal up-regulation in laryngeal carcinomas

BACKGROUND

Galectin-1 has been found to modulate lymphocyte invasion in inflammation and to be involved in angiogenesis in models, thus prompting examination of its clinical relevance in laryngeal cancer.

PATIENTS AND METHODS

Immunohistochemical processing of tissue sections (n=53) from patients with stage I/II (n=35) and stage IV (n=18) laryngeal squamous cell carcinoma (LSCC) with a specific anti-galectin-1 antibody and monitoring of CD45/CD31 positivity was combined with quantitative morphometric analysis.

RESULTS

Lectin presence in the tumor and endothelial cells was positively correlated, while a negative relationship to the number of CD45-positive lymphocytes was demonstrated. No association was seen with the extent of neovascularization. The mean optical density (MOD) of lectin-dependent staining in the tumor stroma was significantly increased compared to normal stroma.

CONCLUSION

Galectin-1 was not associated with angiogenesis in the studied cohort while galectin-1 in endothelial cells may negatively influence lymphocyte invasion and the mean optical density for the stromal galectin-1 signal is up-regulated in tumors.

Antiphospholipid antibodies and multiple organ failure in critically ill cancer patients

OBJECTIVES

To describe the clinical outcomes and thrombotic events in a series of critically ill cancer patients positive for antiphospholipid (aPL) antibodies.

DESIGN

Retrospective case series study.

SETTING

Medical-surgical oncologic intensive care unit (ICU).

PATIENTS AND PARTICIPANTS

Eighteen patients with SIRS/sepsis and multiple organ failure (MOF) and positive for aPL antibodies, included over a 10-month period.

INTERVENTIONS

None

MEASUREMENTS AND RESULTS

aPL antibodies and coagulation parameters were measured up to 48 hours after the occurrence of acrocyanosis or arterial/venous thrombotic events. When current criteria for the diagnosis of aPL syndrome were applied, 16 patients met the criteria for 'probable' and two patients had a definite diagnosis of APL syndrome in its catastrophic form (CAPS). Acrocyanosis, arterial events and venous thrombosis were present in eighteen, nine and five patients, respectively. Sepsis, cancer and major surgery were the main precipitating factors. All patients developed MOF during the ICU stay, with a hospital mortality rate of 72% (13/18). Five patients were discharged from the hospital. There were three survivors at 90 days of follow-up. New measurements of lupus anticoagulant (LAC) antibodies were performed in these three survivors and one patient still tested positive for these antibodies.

CONCLUSIONS

In this small series of patients, we observed a high frequency of auto-antibodies and micro- and macro-vascular thrombotic events in critically ill cancer patients. The coexistence of sepsis or SIRS and aPL antibodies was often associated with MOF and death. More studies are necessary to determine the pathophysiological significance of antiphospholipid antibodies in severely ill cancer patients.

Effect of BCG stimulus on proinflammatory cytokine production in laryngeal cancer

BACKGROUND

Evaluate the production of TNF and IL-6 in the supernatant of peripheral blood mononuclear cell (PBMC) cultures of patients with supraglottic laryngeal cancer before and after surgical treatment.

MATERIALS AND METHODS

Adherent cell cultures were stimulated with LPS and BCG. Fourteen patients with advanced supraglottic laryngeal cancer were studied. Cytokine concentration was determined by ELISA in supernatants of mononuclear cell cultures.

RESULTS

In non-stimulated cultures, lower TNF cytokine levels were detected during the late postoperative (LP) period compared to control (P = 0.02). LP TNF and IL-6 levels were high in cultures stimulated with LPS compared with the preoperative period (PREOP) (P = 0.007; P = 0.008, respectively). Stimulation with BCG led to increased levels of TNF and IL-6 during the LP period compared to control (P = 0.001; P = 0.04, respectively).

CONCLUSION

BCG is able to modulate the immune response of patients with advanced supraglottic laryngeal cancer in vitro, increasing the secretion of TNF and IL-6 by macrophages during the postoperative period.

Therapeutic influence on circulating and monocyte-derived dendritic cells in laryngeal squamous cell carcinoma patients

CONCLUSION

Surgical resection of laryngeal squamous cell carcinoma (LSCC) could be associated with improved circulating myeloid dendritic cell (mDC) number and monocyte-derived dentritic cell (MoDC) function. Although adjunctive radiotherapy after surgery did not effect the normalization of mDC number, it may have an impact on MoDC function.

OBJECTIVE

To investigate the effects of surgery and adjunctive radiotherapy on both circulating dendritic cells (DCs) and MoDCs of LSCC patients.

SUBJECTS AND METHODS

Forty-six patients with LSCC and 15 age-matched healthy control subjects were enrolled in this study. Blood samples were taken before, during, and after conventional treatment from both patients who underwent surgery only (n=18) and those who had adjunctive radiotherapy after tumor removal (n=28). Three-color flow cytometry was used for determination of circulating DC subsets. Moreover, MoDCs were generated utilizing granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4), then the phenotype of MoDCs was measured by flow cytometry and the ability to stimulate autologous T cells was tested in a mixed leukocyte reaction (MLR).

RESULTS

The preoperative mDC counts, MoDC surface molecular expression and stimulatory capacity were impaired in patients in comparison with controls. The number of mDCs and the expression of CD80, CD83, and HLA-DR on MoDCs were significantly increased as compared with those pretreatment in patients who underwent surgery only and in those who had surgery followed by adjunctive radiotherapy. However, the recovery of CD86 expression and allostimulatory activity was only observed in patients who underwent surgery alone.

Expression of PCNA and bcl-2 in basaloid squamous cell carcinoma of the larynx: a controlled study

We investigated the difference in the biologic nature of typical squamous cell carcinoma (SCC) and basaloid SCC (BSCC) of the larynx by studying proliferation and antiapoptotic markers. We performed an immunohistochemical analysis of the expression of proliferating cell nuclear antigen (PCNA) and bcl-2 protein in 15 patients with laryngeal BSCC and 15 stage- and site-matched controls with typical laryngeal SCC. We found no significant difference between the two groups in the PCNA index or the frequency of bcl-2 overexpression, nor did we find any significant difference in survival. Our findings indicate that the biologic nature of typical laryngeal SCC and laryngeal BSCC is similar. In addition, our follow-up data suggest that the clinical course of laryngeal BSCC is no worse than that of typical laryngeal SCC.

HPV-induced recurrent laryngeal papillomatosis: dietary fatty acid and micronutrient intakes

Human papilloma virus (HPV)-induced recurrent laryngeal papillomatosis (RLP) is a chronic debilitating disease often encountered among children of poor socio-economic South African groups. There are a few studies and limited evidence as to what extent nutrition may contribute to this disease. To our knowledge this is the first study that gives an account of dietary FA and micronutrient intakes in RLP patients, according to food frequency questionnaires. The dietary FA profile revealed an excessive linoleic acid (LA) intake syndrome and is also marked by high palmitic acid (PA), oleic acid (OA) and SFA intakes. Research revealed that enhanced LA and PA drive, respectively, mitogenic stimuli and apoptotic resistance during tumorigenesis, whist SFAs are associated with lipid rafts, the Th1 immune response and immunosuppression. Low folate intake, a risk for HPV-infection, and low Zn intake, detrimental for lipid metabolism and immunocompetence, occurred in, respectively, 70% and 20% RLP patients. The poor correlations that were found in RLP patients between essential fatty acids (EFAs) and micronutrients, namely, Mg, Zn and Se, involved in lipid metabolism and immune responses, need proper clarification. Overall, it is plausible that the diet (poor nutrition), a shift in lipid metabolism caused by HPV- infection, environmental smoke and oxidative stress, as well as extra-esophageal acid reflux with secondary inflammation in the larynx are co-factors in the etiology of laryngeal papillomatosis, and that immunocompromised patients are subjected to recurrence. It is imperative to ensure that children with RLP receive proper nutrition and follow a healthy lifestyle to prevent disease recurrence after treatment.

Subglottic MALT lymphoma of the larynx--more attention to the glottis

BACKGROUND

Mucosa-associated lymphoid tissue (MALT) lymphoma of the larynx is a rare but well-documented entity which may arise from chronic inflammatory process. Supraglottic left regions are predominant due to unknown reason.

CASE REPORT

We present the case of a 62-year-old man with a dry cough, stridor and developing exertional dyspnea. This subglottic almost circumferential MALT lymphoma showed a temporary distinct disappearance after cortisone administration during the diagnostic process. Bronchoscopy confirmed the diagnosis of a primary MALT lymphoma of the larynx. The patient received chemotherapy according to CHOP scheme plus rituximab. A reliable post-treatment care period of 15 months showed no sign of recurrence.

CONCLUSION

MALT lymphoma of the larynx are believed to arise from preexisting or acquired lymphoid tissue of the upper airway. Acquired lymphoid tissue is documented in the supraglottic region and may be associated with a chronic inflammatory process. However, in subglottic cases it is unclear whether the chronic inflammation arises from a local or systemic process.

Effect of surgical treatment on lymphoproliferation in advanced supraglottic laryngeal cancer

OBJECTIVES

The capacity of cell immunity to act against tumor cells has been presented as a decisive influence in the prognosis of patients with cancer. The aim of this study was to evaluate lymphoproliferation in nonadherent peripheral blood cell cultures of patients with advanced supraglottic laryngeal cancer.

STUDY DESIGN

Fourteen patients with advanced supraglottic laryngeal cancer were studied prospectively. Lymphoproliferation was quantified by adding 3H-thymidine and measured in counts/minute using liquid scintillation spectrometry. Based on the ratio between stimulated and baseline cultures, the proliferation index was calculated before and 236 +/- 18 days after the surgery.

RESULTS

Lymphoproliferation was lower in patients than in healthy controls (P = .01) in the preoperative as well as in the late postoperative period (P = .006 and P = .02, respectively). However, there was no change from preoperative to late postoperative.

CONCLUSION

Pre- and postoperative results show that patients with advanced supraglottic laryngeal cancer present lymphoproliferation diminished before the surgery, and in the late postoperative period, there was no recovery of immune capacity evaluated by lymphoproliferation measurement.

Down-regulation of zeta chain and zeta-associated protein 70 (Zap 70) expression in circulating T lymphocytes in laryngeal squamous cell carcinoma

OBJECTIVE

To evaluate zeta chain and Zap 70 expression in T lymphocytes of patients with laryngeal cancer in relation to surgical treatment.

STUDY DESIGN

This study investigated, by dual-color flow cytometry, zeta chain and Zap 70 expression in the circulating T lymphocytes of 13 patients with laryngeal cancer patients before and after surgical treatment.

RESULTS

Patients exhibited a significant lower expression of both zeta chain and Zap 70 compared to healthy normal controls; no statistical differences were observed after surgical treatment.

CONCLUSION

The results of this investigation seem to indicate that both the zeta chain and the Zap 70 expression in circulating T lymphocytes are down-regulated in patients with laryngeal cancer and that these changes do not immediately return to normal after surgery. Flow cytometry analysis may represent an easy-to-use procedure for monitoring the immune status of patients with laryngeal cancer.

The role of host immune response and apoptosis in patients with laryngeal squamous cell carcinoma

PURPOSE

To determine whether the combined use of markers of host immune response (HLA-DR) and apoptosis (bax and bcl-2) can predict prognosis in laryngeal carcinoma patients.

PROCEDURES

Immunohistochemical staining for HLA-DR, bax and bcl-2 proteins was investigated retrospectively in 37 patients with laryngeal squamous cell carcinoma. Seven healthy adult males were used as the control group.

RESULTS

HLA-DR antigen expression was detected in the tumor cells of 18 patients (48.6%). Another 18 patients (48.6%) expressed HLA-DR antigen in the peritumoral inflammatory infiltrate, while bax and bcl-2 protein expressions were detected in 17 (45.9%) and 9 (24.3%) patients, respectively. None of the controls expressed any of the proteins studied. bcl-2 and HLA-DR protein expressions of the tumor infiltrate were statistically significant independent prognostic factors suggesting improved survival (p = 0.0272 and p = 0.0285, respectively). bax+/bcl-2- patients demonstrated an unfavorable clinical outcome (p = 0.0298), followed by a significantly increased mean HLA-DR antigen expression observed both in the tumor and the stroma cells (p = 0.024 and p = 0.045, respectively).

CONCLUSIONS

bcl-2 and HLA-DR proteins independently predict a dismal prognosis among laryngeal carcinoma patients. The bax+/bcl-2- protein coexpression pattern correlates with elevated immunohistochemical expression of HLA-DR antigen both by tumor and peritumoral stromal cells.

MESSAGE

bcl-2 and HLA-DR are significant prognostic markers in laryngeal carcinoma patients. Further prospective investigation is required to validate our findings.

Tissue detection of natural killer cells in laryngeal carcinoma

Natural Killer (NK) cells have gained much attention as potential cells in antitumor immune defense mechanisms. In a group of 31 patients with surgically treated squamous cell laryngeal carcinoma, NK cell presence was semiquantitatively assessed by means of immunohistochemistry. A panel of three monoclonal antibodies including anti-CD16, was applied on frozen tissue sections. High CD 16+ cell presence was more frequently detected in poorly differentiated carcinomas (in 6 out of 14 cases) by comparison to carcinomas of high to moderate degrees of differentiation (in 1 out of 16 cases, p=0.031). No other clinicopathological variable appeared to influence NK cell presence in the examined specimens. No relation between NK cell detection and relapse-free survival emerged. Poorly differentiated laryngeal cancer cells appear to trigger off a greater NK cell tissue response than well and moderately differentiated cancer cells; however, the potential prognostic impact of this observation remains to be established.

Assessment of expression of toll-like receptors 2, 3 and 4 in laryngeal carcinoma

Head and neck cancers remain a big challenge for oncology. Among them laryngeal carcinomas predominate. In spite of abundant inflammatory cell infiltrates containing several immunologically competent cells, patients with head and neck cancers show markedly suppressed anti-tumor response. In general, cancer cells use strategies to avoid recognition and destruction by the immune system. Toll-like receptors 1-13 (TLRs) are crucial for activation of innate immunity and secondarily for the induction of acquired response. TLRs are mainly expressed on cells of the immune system, but they have been demonstrated on endothelial and epithelial cells. Ligand binding to TLR leads to the activation of several genes, predominantly proinflammatory ones such as IL-1 and TNF-alpha and maturation of professional antigen presenting cells (APC) i.e., dendritic cells. It can cause better tumor antigen presentation by APC. The aim of this study was the evaluation of expression of TLR-2, TLR-3 and TLR-4 in the microenvironment of laryngeal carcinoma. Tumor specimens (n = 20, male patients aged 43-77 years, mean 57 years) from patients subjected to total laryngectomy. Immunohistochemistry and indirect immunoflourescence on frozen tissue sections. Cancer tissue: portion of cancer cells manifested membrane and/or cytoplasmic expression of TLR-2, TLR-3 and TLR-4. The most frequent expression on tumor cells was TLR-2 and the least expression of TLR-4. Inflammatory infiltrates: in all cases inflammatory cell infiltrates of various intensities were present, both in tumor mass and tumor stroma. Expression of all TLRs tested, both, membrane and cytoplasmic ones were shown on inflammatory cells, but distinct in quantitative terms. TLR-4 positive cells were the most frequent. A portion of cells expressed both, TLR and HLA-DR. It is of interest that TLRs tested were expressed not only on cells of inflammatory infiltrate, but also on tumor cells. This fact may be an important factor in tumor escape from immune surveillance. It is notable, that both, TLRs and HLA-DR were shown to be co-expressed, what may favor the role and impact of TLRs in antigen presentation. Further studies are needed to elucidate TLRs function in the course of neoplastic process.

HLA class I antigen down-regulation in primary laryngeal squamous cell carcinoma lesions as a poor prognostic marker

We have investigated the role of antigen-processing machinery (APM) component defects in HLA class I antigen down-regulation in laryngeal squamous cell carcinoma (SCC) lesions and assessed the clinical significance of these defects. To this end, 63 formalin-fixed, paraffin-embedded tumor lesions were examined for APM component and HLA class I antigen expression by immunohistochemistry. Calnexin, calreticulin, and ERp57 were down-regulated in approximately 25% of the lesions tested, whereas LMP2, TAP1, tapasin, and HLA class I antigens were down-regulated in at least 70% of the lesions tested. LMP2 and tapasin expression was significantly correlated with HLA class I antigen expression suggesting APM component defects as a mechanism underlying HLA class I antigen down-regulation in laryngeal SCC lesions. The expression of most APM components and HLA class I antigens was correlated with the extent of CD8+ T cell infiltration into tumor lesions. Furthermore, LMP2 and HLA class I antigen down-regulation and low CD8+ T cell infiltration were significantly associated with reduced patients' survival. Multivariate analysis identified HLA class I antigen down-regulation as an independent unfavorable prognostic marker. This association is likely to reflect the reduction in the extent of CD8+ T cell infiltration in laryngeal SCC lesions.

High level expression of human epithelial beta-defensins (hBD-1, 2 and 3) in papillomavirus induced lesions

Background

Epithelial defensins including human β-defensins (hBDs) and α-defensins (HDs) are antimicrobial peptides that play important roles in the mucosal defense system. However, the role of defensins in papillomavirus induced epithelial lesions is unknown.

Results

Papilloma tissues were prospectively collected from 15 patients with recurrent respiratory papillomatosis (RRP) and analyzed for defensins and chemokine IL-8 expression by quantitative, reverse-transcriptase polymerase chain reaction (RT-PCR) assays. HBD-1, -2 and -3 mRNAs were detectable in papilloma samples from all RRP patients and the levels were higher than in normal oral mucosal tissues from healthy individuals. Immunohistochemical analysis showed that both hBD-1 and 2 were localized in the upper epithelial layers of papilloma tissues. Expression of hBD-2 and hBD-3 appeared to be correlated as indicated by scatter plot analysis (r = 0.837, p < 0.01) suggesting that they were co-inducible in papillomavirus induced lesions. Unlike hBDs, only low levels of HD5 and HD6 were detectable in papillomas and in oral mucosa.

Conclusion

Human β-defensins are upregulated in respiratory papillomas. This novel finding suggests that hBDs might contribute to innate and adaptive immune responses targeted against papillomavirus-induced epithelial lesions.

Inhibition of nuclear factor kappa B (NFkappaB) activity in oral tumor cells prevents depletion of NK cells and increases their functional activation

The aim of this study is to identify candidate factors which may be responsible for the functional inactivation and depletion of NK cells by tumor cells. Inhibition of NFkappaB activity by an IkappaB super-repressor in HEp2 cells, a cell line commonly used as an oral tumor model, blocked tumor-induced NK cell death, and increased the function of NK cells significantly. Increased expression of CD69 early activation antigen on NK cells as well as augmented proliferation and secretion of IFN-gamma by NK cells were observed when these cells were co-incubated with IkappaB super-repressor transfected HEp2 cells (HEp2-IkappaB((S32AS36A))). More importantly, the secretion of IL-6 was significantly inhibited when NK cells were co-cultured with HEp2-IkappaB((S32AS36A)) cells. In addition, the survival and function of cytotoxic effector cells remained significantly elevated in the presence of IFN-gamma-treated HEp2-IkappaB((S32AS36A)) cells when compared to either untreated or IFN-gamma-treated vector-alone transfected HEp2 cells. Similar findings to those obtained using purified peripheral blood NK cells were also observed when non-fractionated peripheral blood mononuclear cells were used in the co-cultures of immune effectors with HEp2 cell transfectants. Addition of recombinant human IL-6 to the co-cultures of immune effectors with the NFkappaB knockdown HEp2 tumor cells substantially decreased the levels of secreted IFN-gamma. Thus, the results presented in this paper suggest that the inhibition of NFkappaB function in oral tumors may serve to activate and expand the function and numbers of NK cells. Moreover, NFkappaB-mediated increase in IL-6 secretion by oral tumors may in part be responsible for the observed inactivation and death of the immune effectors.

Anti-proteasome autoantibodies contribute to anti-nuclear antibody patterns on human larynx carcinoma cells

BACKGROUND

Autoantibodies to the 20S proteasome represent an unspecific but common serological phenomenon in patients with systemic autoimmune diseases. Interestingly, a high prevalence of these antibodies have been observed in patients with connective tissue diseases, where anti-nuclear antibodies (ANAs) serve as an important diagnostic screening test.

OBJECTIVE

To disclose interference of anti-proteasome antibodies with known ANA patterns.

METHODS

Anti-proteasome antibodies were isolated for comprehensive immunofluorescence analyses. The immunofluorescence pattern of human anti-proteasome antibodies was compared with a panel of monoclonal and polyclonal reference antibodies, and colocalisation was analysed using confocal microscopy.

RESULTS

Anti-proteasome antibodies clearly contributed to the ANA patterns of their respective serum samples from patients with different rheumatic disorders. In addition to the nuclear pattern, proteasomal staining was also detectable in the cytoplasm, at the endoplasmic reticulum and perinuclear regions showing features overlapping with other known autoantibodies such as those to mitochondria. The specificity of anti-proteasome antibodies was proved by competition experiments and by colocalisation with monoclonal reference antibodies in confocal microscopy.

CONCLUSION

In ANA diagnostics, interference of anti-proteasome antibodies will have to be taken into account, especially in the differentiation of anti-cytoplasmatic autoantibodies.

[Interleukin-10 in laryngeal cancer patients treated by surgery or radiotherapy]

INTRODUCTION

The early detection and right monitoring of the laryngeal cancer make a better chance of recovery. Therefore factors that might be showing the presence of neoplastic process are constantly being looked for. The detection of correlation between incidence of cancer and immunity system disorders makes us look for and try to answer an important question: are there any factors that might be cancer markers in immunity system? Cytokines are molecules that regulate the process of differentiation and proliferation. They are also the mediators of immunological and inflammatory reactions. Interleukina-10 (IL-10) is a cytokine that has various important functions stimulating immunity processes. IL-10 is a factor stimulating killer cells/cytoxic lymphocytes/ and is able to kill cancer cells growth spontaneously. It has been detected that some cancer cells can produce some IL-10, too. The aim of the study was to evaluate the serum level concentration of IL-10 in the laryngeal cancer patients before any medical treatment and its denotation after surgery or radiotherapy.

MATERIAL AND METHODS

A group of 43 male patients with laryngeal cancer was considered for the purpose of this study. 22 patients were treated by surgery and 21 by radiotherapy. In all the cases the serum concentration of IL-10 before the treatment, in the first and 30th days after therapy was evaluated. The results were compared with the group of 20 healthy volunteers.

RESULTS

The mean value of IL-10 concentration in laryngeal cancer patients treated by surgery was 14.0 pg/ml before treatment, 12.8 pg/ml in the 1 day and 14.4 pg/ml 30 days after the therapy. IL-10 concentrations in patients treated by radiotherapy were respectively: 15.4, 14.4 and 15.9 pg/ml. The mean value of IL-10 in the control group was 4.9 pg/ml. The serum concentrations of IL-10 in the laryngeal cancer patients were significantly higher than in the control group. These IL-10 concentrations didn't change significantly after the surgery or radiotherapy.

CONCLUSION

The serum concentration of IL-10 in the laryngeal cancer patients is significantly higher than in the healthy control group. The changes of serum concentrations after the surgery or radiotherapy of laryngeal cancer patients are not significant and characteristic.